This issue of Topics includes a variety of articles that address challenges of daily life, including neurogenic bowel, pressure injuries, health disparities, and tolerance to exercise. The first paper (Choukou et al) is a systematic review of quality of life (QoL) tools for assessing neurogenic bowel dysfunction (NBD) after SCI. Thirteen tools assessing the influence of NBD on QoL in SCI are discussed. The Health Utility Index (HUI-III) is the only tool identified that provided data on “QoL as Utility” on the impact of NBD but was not developed specifically for SCI. Whereas, the validated NBD score is the only condition-specific tool to assess QoL as subjective well-being. Further validation of existing tools would help to inform practice and policy related to NBD management. The second paper (Boucher et al) finds colostomy to be a safe and effective option when performed early after SCI, improving independence and making bowel care easier and more acceptable to the newly injured patient.

The third paper (Sleight et al) is a qualitative study that looks at the complex interplay of risk and protective factors for pressure injuries in underserved adults with SCI. Although some protective factors (eg, personal traits) may be inherent and nonmodifiable, future interventions for this population may benefit from a focus on acquisition of medical equipment and facilitation of sustainable, health-promoting habits and routines. Substantive policy changes may be necessary to facilitate access to adequate resources, particularly housing and equipment, for socioeconomically disadvantaged individuals with SCI.

The following two articles (study the critical issues of participation and health care needs in two at-risk SCI populations: low- and middle-income countries (LMICs) (Alve & Bontje) and those who are aging (Kern et al). The first is a scoping review to identify factors that influence participation in daily activities by persons with SCI living in high-income countries (HICs) and in LMICs. Eight lessons are proposed to enhance health and functional abilities, ensure disability-friendly environments, develop social justice, and provide empowerment to enhance participation in daily activities among person with SCI living in LMICs. The second paper is a qualitative study exploring changing health care needs of individuals aging with SCI and their caregivers in order to identify environmental supports and barriers to achieving long-term health and treatment outcomes.

The next two papers study aspects of exercise in the SCI population. The first paper (Trbovich) is a pilot study of the efficacy of five cooling techniques during exercise in persons with SCI, with water spray at 90°F being the most efficacious. The second paper (Phadke et al) is a systematic review looking at the impact of passive leg cycling in persons with SCI. The last article of this issue of Topics is a case report on the interdisciplinary, intensive, activity-based treatment for intrauterine spinal cord infarct.

We hope you enjoy this issue and look forward to your future submissions. Wishing you and your families a healthy and joyful 2019!

Wishing you and your families a healthy and joyful 2019!

—Lawrence C. Vogel, MD

—Kathy Zebracki, PhD